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7 Dec 2012




       eHealth Challenges
       Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM
       Chief, UP College of Medicine Medical Informatics Unit
       Associate Professor 4, UP College of Medicine
       Section of Endocrinology, Diabetes & Metabolism,
       Philippine General Hospital




                                                                                   “Unitron Sky Walker” by pasukaru76,
                                                                http://www.flickr.com/photos/pasukaru76/6271854325/
Saturday, December 8, 12
http://www.engineeringchallenges.org/cms/8996/9221.aspx
Saturday, December 8, 12
http://www.engineeringchallenges.org/cms/8996/9221.aspx
Saturday, December 8, 12
Provide energy
                                          Restore &                             Develop carbon
                       from fusion
                                       improve urban                             sequestration
                                        infrastructure                             methods


                      Make solar                             Advance
                        energy                             personalized
                      economical                             learning

Prevent                                  Engineer                                   Reverse-
nuclear                                   better                                    engineer
 terror                                  medicines                                  the brain

                        Provide                              Advance
                       access to                              health
                      clean water                          informatics
                                           Secure                                    Manage the
                                         cyberspace                                 nitrogen cycle
                      Enhance
                    virtual reality
                                      Engineer the tools
                                         of scientific
                                          discovery                “jigsaw puzzle” by spekulator, http://www.sxc.hu/photo/944284
Saturday, December 8, 12
Kulikowski et al. AMIA
                                                Board white paper: definition of
                                biomedical informatics and specification of core
                           competencies for graduate education in the discipline.
                                                        J Am Med Inform Assoc 2012;19:931-8.
Saturday, December 8, 12
Kulikowski et al. AMIA
                                                Board white paper: definition of
                                biomedical informatics and specification of core
                           competencies for graduate education in the discipline.
                                                        J Am Med Inform Assoc 2012;19:931-8.
Saturday, December 8, 12
Electronic
                                                                Medical Record



                                                        Systems for improved
                                                            patient education
                                                             and compliance


                            eHealth
                           Challenges                                   Data mining
                                                                         for medical
                            Center for Development of                    knowledge
                           Advanced Computing (India)
                                                                                      Image from katerha,
                                                        http://www.flickr.com/photos/katerha/5021019816/
Saturday, December 8, 12
Electronic
                                                                Medical Record




                            eHealth
                           Challenges
                            Center for Development of
                           Advanced Computing (India)
                                                                                      Image from katerha,
                                                        http://www.flickr.com/photos/katerha/5021019816/
Saturday, December 8, 12
http://www2.fraserhealth.ca/media/how%20hazardous%20is%20healthcare%202.jpg
Saturday, December 8, 12
To Err is Human:
         Adverse            Building a Safer Health System
          events            Institute of Medicine 1999


              2.9%               6.6-13.6%

                                                         Ooops
                                   mortality
             Colorado       44,000 -
              & Utah
                             98,000        50%
              3.7%         deaths/year Medical
              New York
                                        Errors
Saturday, December 8, 12
http://www.youtube.com/watch?v=7Ks3hezVSIM




Saturday, December 8, 12
Electronic Medical Record (EMR)




                           Core application for patient-
                           specific information
Saturday, December 8, 12
EMR: Challenges


                           Structured data entry vs free text

                               Y   N    Visual disturbances
                               Y   N    Eye itching
                               Y   N    Eye pain
Saturday, December 8, 12
EMR: Challenges
        Universally agreed-on medical vocabulary
        or standard terminology




Saturday, December 8, 12
EMR: Challenges
                            • Protection of
                              patient privacy and
                              confidentiality
                             –Health Insurance
                              Portability and
                              Accountability Act
                              (1996)




Saturday, December 8, 12
Good information
                                              Michael E. DeBakey, MD
                      is the best medicine.
Saturday, December 8, 12
http://youtu.be/2ikjOSmqpyo




Saturday, December 8, 12
EMR: Challenges




          Usability
          Integrate EMR into busy clinical workflow


Saturday, December 8, 12
“NextGen is unusable”
                                          by juhansonin,
                           http://www.flickr.com/photos/
                                juhansonin/3857845956/


Saturday, December 8, 12
EMR: Challenges
                           Optimal computing device
                           for the clinical setting?




Saturday, December 8, 12
Incident record

                                 Data generated when
                             individual interacts with HCP


                                  Patient record
                            A series of incident records
                            generated by specific HCP


                                  Health record

                            All patient records generated
                           over an individual’s lifetime by
                           all HCPs who provide services
                                               http://www.hc-sc.gc.ca/ohih-bsi/
Saturday, December 8, 12
http://youtu.be/Lo_3qOejQzI




Saturday, December 8, 12
EMR: Challenges
        • Standards: to facilitate integration of
          data, especially across systems from
          different vendors

                                   –Digital Imaging &
                                    Communications in
                                    Medicine (DICOM)
                                   –Health Level 7 (HL7)




Saturday, December 8, 12
http://www.emrindustry.com/index.php/will-next-generation-emrs-be-platform-stack-of-apps/


Saturday, December 8, 12
“The utopic future of medicine will
                           seamlessly combine data from your daily
                            apps and personalize a health treatment
                            plan based on the life you actually live.”

                           http://www.carepractice.com/emr-needs-a-kick-in-the-app-hole/
Saturday, December 8, 12
Saturday, December 8, 12
http://vimeo.com/38063992




Saturday, December 8, 12
“As opposed to the doctor-centric, curative
                           model of the past, the future is going to be
                                      patient-centric and proactive.”
                                                  Elias A. Zerhouni MD, NIH Director
                                                                          Dec 2007




                                                                                         Image by JD Hancock
                                                           http://www.flickr.com/photos/jdhancock/4100030094/
Saturday, December 8, 12
“Movement in which networked patients
                                       shift from being mere passengers to
                                      responsible drivers of their health ...
                                                   providers encourage and
                                                 value them as full partners”
                                                         Society for Participatory Medicine




Image by Liz Grace
http://www.flickr.com/photos/liz-grace/5078868809/




                    Participatory Medicine
Saturday, December 8, 12
Personal Health Record
    • Provider-owned and                • Patient-owned
      provider-maintained                 software program
      digital summary                   – Patient can enter,
          – Read-only for patient         organize, retrieve own
          – Access to lab results         health information
            through a password-         – Web-based i.e. Google
            protected Web site            Health, Microsoft
          – Commercial EHRs offer         HealthVault
            digital summaries
            through patient portals



                                          Endsley et al. An Introduction to Personal Health
                                                           Records http://www.afp.org/fpm
Saturday, December 8, 12
Personal Health Record
        • Portable, interoperable digital file
              –Selected, clinically relevant health data can be
               managed, secured and transferred
              –Platforms: Smart cards, PDAs, cellphones,
               USB-compatible devices




                                  Endsley et al. An Introduction to Personal Health Records
                                                                      http://www.afp.org/fpm
Saturday, December 8, 12
Saturday, December 8, 12
No longer fill out forms
                                                                 Authentication
                                                    Protection from fraud if lost
                            Rapid access to previously unavailable information
                           Paperwork for health record transfers are eliminated
                            Electronic prescriptions can be stored on the card



Saturday, December 8, 12
Systems for improved
                                                            patient education
                                                             and compliance


                            eHealth
                           Challenges
                            Center for Development of
                           Advanced Computing (India)
                                                                                      Image from katerha,
                                                        http://www.flickr.com/photos/katerha/5021019816/
Saturday, December 8, 12
http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-compliance
Saturday, December 8, 12
http://www.ama-assn.org/amednews/2010/05/10/bisb0510.htm

Saturday, December 8, 12
Gamification
                                use of game play mechanisms
                                  for non-game applications




                           http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/
Saturday, December 8, 12
http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watch
Saturday, December 8, 12
eHealth
                           Challenges                                   Data mining
                                                                         for medical
                            Center for Development of                    knowledge
                           Advanced Computing (India)
                                                                                      Image from katerha,
                                                        http://www.flickr.com/photos/katerha/5021019816/
Saturday, December 8, 12
Saturday, December 8, 12
Slide from presentation of Desikan et al, 2011 Siam International Conference on Data Mining
Saturday, December 8, 12
We are drowning in
   data but starving for
   knowledge!



   clinical decision
   support

   healthcare resource
   management



                           “toes” by basheertome, http://www.flickr.com/photos/basheertome/7001981033/

Saturday, December 8, 12
Challenges in Data
 Mining for Healthcare

  data set from various
  data sources

  bias from
  heterogeneous data

  missing values, noise
  and outliers
  protection of security,
  integrity and privacy

                            Pink Sherbet photography, http://www.flickr.com/photos/pinksherbet/4621820292/

Saturday, December 8, 12
Electronic
                                                                Medical Record



                                                        Systems for improved
                                                            patient education
                                                             and compliance


                            eHealth
                           Challenges                                   Data mining
                                                                         for medical
                            Center for Development of                    knowledge
                           Advanced Computing (India)
                                                                                      Image from katerha,
                                                        http://www.flickr.com/photos/katerha/5021019816/
Saturday, December 8, 12
Thank You
            http://www.endocrine-witch.net
                        @endocrine_witch




                                             Image from http://wthr.frumph.net/

Saturday, December 8, 12

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ehealth Challenges

  • 1. 7 Dec 2012 eHealth Challenges Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM Chief, UP College of Medicine Medical Informatics Unit Associate Professor 4, UP College of Medicine Section of Endocrinology, Diabetes & Metabolism, Philippine General Hospital “Unitron Sky Walker” by pasukaru76, http://www.flickr.com/photos/pasukaru76/6271854325/ Saturday, December 8, 12
  • 4. Provide energy Restore & Develop carbon from fusion improve urban sequestration infrastructure methods Make solar Advance energy personalized economical learning Prevent Engineer Reverse- nuclear better engineer terror medicines the brain Provide Advance access to health clean water informatics Secure Manage the cyberspace nitrogen cycle Enhance virtual reality Engineer the tools of scientific discovery “jigsaw puzzle” by spekulator, http://www.sxc.hu/photo/944284 Saturday, December 8, 12
  • 5. Kulikowski et al. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. J Am Med Inform Assoc 2012;19:931-8. Saturday, December 8, 12
  • 6. Kulikowski et al. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. J Am Med Inform Assoc 2012;19:931-8. Saturday, December 8, 12
  • 7. Electronic Medical Record Systems for improved patient education and compliance eHealth Challenges Data mining for medical Center for Development of knowledge Advanced Computing (India) Image from katerha, http://www.flickr.com/photos/katerha/5021019816/ Saturday, December 8, 12
  • 8. Electronic Medical Record eHealth Challenges Center for Development of Advanced Computing (India) Image from katerha, http://www.flickr.com/photos/katerha/5021019816/ Saturday, December 8, 12
  • 10. To Err is Human: Adverse Building a Safer Health System events Institute of Medicine 1999 2.9% 6.6-13.6% Ooops mortality Colorado 44,000 - & Utah 98,000 50% 3.7% deaths/year Medical New York Errors Saturday, December 8, 12
  • 12. Electronic Medical Record (EMR) Core application for patient- specific information Saturday, December 8, 12
  • 13. EMR: Challenges Structured data entry vs free text Y N Visual disturbances Y N Eye itching Y N Eye pain Saturday, December 8, 12
  • 14. EMR: Challenges Universally agreed-on medical vocabulary or standard terminology Saturday, December 8, 12
  • 15. EMR: Challenges • Protection of patient privacy and confidentiality –Health Insurance Portability and Accountability Act (1996) Saturday, December 8, 12
  • 16. Good information Michael E. DeBakey, MD is the best medicine. Saturday, December 8, 12
  • 18. EMR: Challenges Usability Integrate EMR into busy clinical workflow Saturday, December 8, 12
  • 19. “NextGen is unusable” by juhansonin, http://www.flickr.com/photos/ juhansonin/3857845956/ Saturday, December 8, 12
  • 20. EMR: Challenges Optimal computing device for the clinical setting? Saturday, December 8, 12
  • 21. Incident record Data generated when individual interacts with HCP Patient record A series of incident records generated by specific HCP Health record All patient records generated over an individual’s lifetime by all HCPs who provide services http://www.hc-sc.gc.ca/ohih-bsi/ Saturday, December 8, 12
  • 23. EMR: Challenges • Standards: to facilitate integration of data, especially across systems from different vendors –Digital Imaging & Communications in Medicine (DICOM) –Health Level 7 (HL7) Saturday, December 8, 12
  • 25. “The utopic future of medicine will seamlessly combine data from your daily apps and personalize a health treatment plan based on the life you actually live.” http://www.carepractice.com/emr-needs-a-kick-in-the-app-hole/ Saturday, December 8, 12
  • 28. “As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive.” Elias A. Zerhouni MD, NIH Director Dec 2007 Image by JD Hancock http://www.flickr.com/photos/jdhancock/4100030094/ Saturday, December 8, 12
  • 29. “Movement in which networked patients shift from being mere passengers to responsible drivers of their health ... providers encourage and value them as full partners” Society for Participatory Medicine Image by Liz Grace http://www.flickr.com/photos/liz-grace/5078868809/ Participatory Medicine Saturday, December 8, 12
  • 30. Personal Health Record • Provider-owned and • Patient-owned provider-maintained software program digital summary – Patient can enter, – Read-only for patient organize, retrieve own – Access to lab results health information through a password- – Web-based i.e. Google protected Web site Health, Microsoft – Commercial EHRs offer HealthVault digital summaries through patient portals Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm Saturday, December 8, 12
  • 31. Personal Health Record • Portable, interoperable digital file –Selected, clinically relevant health data can be managed, secured and transferred –Platforms: Smart cards, PDAs, cellphones, USB-compatible devices Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm Saturday, December 8, 12
  • 33. No longer fill out forms Authentication Protection from fraud if lost Rapid access to previously unavailable information Paperwork for health record transfers are eliminated Electronic prescriptions can be stored on the card Saturday, December 8, 12
  • 34. Systems for improved patient education and compliance eHealth Challenges Center for Development of Advanced Computing (India) Image from katerha, http://www.flickr.com/photos/katerha/5021019816/ Saturday, December 8, 12
  • 37. Gamification use of game play mechanisms for non-game applications http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/ Saturday, December 8, 12
  • 39. eHealth Challenges Data mining for medical Center for Development of knowledge Advanced Computing (India) Image from katerha, http://www.flickr.com/photos/katerha/5021019816/ Saturday, December 8, 12
  • 41. Slide from presentation of Desikan et al, 2011 Siam International Conference on Data Mining Saturday, December 8, 12
  • 42. We are drowning in data but starving for knowledge! clinical decision support healthcare resource management “toes” by basheertome, http://www.flickr.com/photos/basheertome/7001981033/ Saturday, December 8, 12
  • 43. Challenges in Data Mining for Healthcare data set from various data sources bias from heterogeneous data missing values, noise and outliers protection of security, integrity and privacy Pink Sherbet photography, http://www.flickr.com/photos/pinksherbet/4621820292/ Saturday, December 8, 12
  • 44. Electronic Medical Record Systems for improved patient education and compliance eHealth Challenges Data mining for medical Center for Development of knowledge Advanced Computing (India) Image from katerha, http://www.flickr.com/photos/katerha/5021019816/ Saturday, December 8, 12
  • 45. Thank You http://www.endocrine-witch.net @endocrine_witch Image from http://wthr.frumph.net/ Saturday, December 8, 12